標準的治療で炎症を十分に抑止できない結核性髄膜炎—治療抵抗性の結核性髄膜炎

Tuberculous Meningitis in Which Inflammation Cannot Be Adequately Suppressed by Standard Therapy: Treatment-Resistant Tuberculous Meningitis

結核性髄膜炎の概説を提示したうえで，標準的治療に抵抗する病態などを取り上げた。具体的には初期悪化，脳結核腫，脳室炎，ヒト免疫不全ウイルス感染症合併の症例に対して，ステロイドパルス療法，イソニアジド髄腔内投与，免疫再構築症候群，薬剤耐性結核などを紹介した。本疾患は比較的稀だが，予後は依然として悪い場合も多く，難治性病態とその対応も把握することが望ましい。

Abstract

To understand tuberculous meningitis (TBM), its clinical features and standard therapy were briefly reviewed. In addition, to determine the therapeutic strategies for treatment-resistant TBM, several clinical cases, including those with paradoxical reaction, ventriculitis, cerebral tuberculoma, and human immunodeficiency virus (HIV) co-infection, are presented. Steroid pulse therapy and intrathecal isoniazid administration are discussed as specific therapeutic strategies. Immune reconstitution inflammatory syndrome in patients with TBM suffering from HIV co-infection and alternative drug selection for drug-resistant TBM cases are also introduced. Although TMB is a rare central nervous system infection, it remains a serious disease with high rates of mortality and neurological sequelae. Knowing therapeutic strategies for treatment-resistant TBM is necessary to prevent a devastating prognosis.